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General NPI Number Information
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NPI Number | 1710686118
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Entity Type | Individual
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Provider Name | BRANDON LA OD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 4020 W PLANO PKWY
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City | PLANO
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State | TX
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Zip | 75093-5613
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Country | US
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Telephone | 469-999-2747
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Fax | 469-606-0925
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Provider Business Mailing Address
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Address Line | 250 AVENUE K SW STE 200
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3919
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 10779T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10779T
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License Number State | TX
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